WO2009051698A2 - Intubation endotrachéale guidée par cathéter - Google Patents

Intubation endotrachéale guidée par cathéter Download PDF

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Publication number
WO2009051698A2
WO2009051698A2 PCT/US2008/011719 US2008011719W WO2009051698A2 WO 2009051698 A2 WO2009051698 A2 WO 2009051698A2 US 2008011719 W US2008011719 W US 2008011719W WO 2009051698 A2 WO2009051698 A2 WO 2009051698A2
Authority
WO
WIPO (PCT)
Prior art keywords
endoscope
imaging
guide device
guide
tube
Prior art date
Application number
PCT/US2008/011719
Other languages
English (en)
Other versions
WO2009051698A3 (fr
Inventor
Kai Matthes
Original Assignee
Beth Israel Deaconess Medical Center
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Beth Israel Deaconess Medical Center filed Critical Beth Israel Deaconess Medical Center
Publication of WO2009051698A2 publication Critical patent/WO2009051698A2/fr
Publication of WO2009051698A3 publication Critical patent/WO2009051698A3/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/267—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for the respiratory tract, e.g. laryngoscopes, bronchoscopes
    • A61B1/2676—Bronchoscopes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00064—Constructional details of the endoscope body
    • A61B1/00071—Insertion part of the endoscope body
    • A61B1/0008—Insertion part of the endoscope body characterised by distal tip features
    • A61B1/00098—Deflecting means for inserted tools
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00064—Constructional details of the endoscope body
    • A61B1/00071—Insertion part of the endoscope body
    • A61B1/0008—Insertion part of the endoscope body characterised by distal tip features
    • A61B1/00101—Insertion part of the endoscope body characterised by distal tip features the distal tip features being detachable
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00131—Accessories for endoscopes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00131—Accessories for endoscopes
    • A61B1/0014—Fastening element for attaching accessories to the outside of an endoscope, e.g. clips, clamps or bands
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/005—Flexible endoscopes
    • A61B1/0051—Flexible endoscopes with controlled bending of insertion part
    • A61B1/0052—Constructional details of control elements, e.g. handles
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/012—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor
    • A61B1/0125—Endoscope within endoscope
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/012—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor
    • A61B1/018—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor for receiving instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/267—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for the respiratory tract, e.g. laryngoscopes, bronchoscopes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/267—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for the respiratory tract, e.g. laryngoscopes, bronchoscopes
    • A61B1/2673—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for the respiratory tract, e.g. laryngoscopes, bronchoscopes for monitoring movements of vocal chords
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/04—Tracheal tubes
    • A61M16/0486—Multi-lumen tracheal tubes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/04—Tracheal tubes
    • A61M16/0488—Mouthpieces; Means for guiding, securing or introducing the tubes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/04—Tracheal tubes
    • A61M16/0434—Cuffs

Definitions

  • Tracheal intubation is a procedure involving the placement of a tube through the oral cavity, larynx, vocal cords and into the trachea.
  • a laryngoscope is commonly used to view the glottis during placement of the endotracheal tube .
  • the endotracheal tube often has a cuff that is inflated to form a seal with the interior walls of the trachea to prevent aspiration into the lungs.
  • the present invention relates to systems and methods for endoscopic visualization of intubation using a guide device such as a catheter or endoscope for a procedure referred to herein as guided endotracheal intubation.
  • a preferred embodiment of the invention includes the introduction of an imaging endoscope into the oropharynx of a patient's airway to provide direct visualization of the tracheal entry region.
  • a guide device can be used to deliver an endotracheal tube that is placed into the trachea under direct visualization with the imaging endoscope.
  • the guide device and/or the intubation tube can also be guided into position using the imaging endoscope at which point the guide device or endotracheal tube can be separated from the imaging endoscope for delivery of the endotracheal tube into the trachea.
  • a smaller imaging endoscope and a small diameter guide device and endotracheal tube can be used for pediatric applications in which the critical anatomical features have smaller dimensions.
  • a clear distal cap on the tip of the endoscope facilitates the visibility as it helps to keep tissue at a fixed distance from the lens instead of obstructing the view.
  • Fig. 4 illustrates use of an endotracheal intubation endoscope system in accordance with a preferred embodiment of the invention.
  • the endoscope needs to be withdrawn to separate the guide catheter from the endoscope before the catheter can be used to guide the endotracheal tube through the vocal cords into the airway.
  • the endoscope needs to be reinserted alongside the guide catheter to observe the endotracheal intubation. In some patients this step may be omitted as the guide catheter can be used clinically to intubate the trachea blindly without endoscopic visualization.
  • the observation of the intubation step provides an enhanced safety feature particularly for patients presenting more difficult issues for intubation.
  • the length of the smaller endoscope can be about 200-400 mm longer than the large endoscope that can have a length 200-600 mm, for example, thus providing a smaller diameter endoscope that is longer than 500 mm, preferably about 700-800 mm.
  • the diameter of the second smaller endoscope is preferably at least 1 mm smaller than the working channel 16, preferably about 2-3 mm in diameter.
  • Existing pediatric bronchoscopes for example, have dimensions suitable for use.
  • Illustrated in Fig. 6 is the insertion of catheter 104 through the proximal entry port 127 into the enclosed working channel 106.
  • the endoscope is inserted over the tongue 117 to view the epiglottis 130, and the trachea 125.
  • the epiglottis 130 can be lifted up with the guide device to display the vocal cords and the entry into the trachea.
  • the smaller guide device 104 extending past vocal cords 139, comprises a small diameter endoscope having a separate processor housing 160 that can be connected to the proximal end.
  • the smaller endoscope has a separate light source and imaging detector in housing 160 and can have a second control panel with separate switches to control imaging, suction and insufflation functions of endoscope 104.
  • the working channel 106 has a panel 136 that moves to open the working channel so that the catheter or endoscope 104 can be removed and allow the tube 105 to be inserted into position alongside endoscope 118 as shown in Fig. 9.
  • the optional cuff 203 can be situated between elements 209 and 210, for example, which can connect the endoscope to the endotracheal tube, i.e. the holders attach on first and second portions of the tube on different sides of the cuff.
  • the holder elements are positioned along the steerable portion of the endoscope such that when the distal end of the endoscope is bent, the tube 202 has a bending region also bends to conform to the curved shape of the endoscope .
  • a guide catheter 204 can also be used with the older elements 206, 209, 210 or a track facilitate positioning of tube 202.

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Animal Behavior & Ethology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Biomedical Technology (AREA)
  • Engineering & Computer Science (AREA)
  • Pulmonology (AREA)
  • Physics & Mathematics (AREA)
  • Pathology (AREA)
  • Optics & Photonics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Biophysics (AREA)
  • Radiology & Medical Imaging (AREA)
  • Otolaryngology (AREA)
  • Physiology (AREA)
  • Emergency Medicine (AREA)
  • Anesthesiology (AREA)
  • Hematology (AREA)
  • Endoscopes (AREA)
  • Instruments For Viewing The Inside Of Hollow Bodies (AREA)

Abstract

La présente invention porte sur un endoscope d'intubation endotrachéale guidée. Un cathéter de guidage est utilisé pour positionner un endoscope et un tube pour une intubation d'un patient. L'endoscope peut comprendre un dispositif d'orientation servant à orienter l'endoscope dans au moins deux directions, ainsi que des dispositifs d'aspiration, d'irrigation et de retrait destinés à maintenir un champ de vision dégagé.
PCT/US2008/011719 2007-10-12 2008-10-14 Intubation endotrachéale guidée par cathéter WO2009051698A2 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US99872907P 2007-10-12 2007-10-12
US60/998,729 2007-10-12

Publications (2)

Publication Number Publication Date
WO2009051698A2 true WO2009051698A2 (fr) 2009-04-23
WO2009051698A3 WO2009051698A3 (fr) 2009-07-02

Family

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Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/US2008/011719 WO2009051698A2 (fr) 2007-10-12 2008-10-14 Intubation endotrachéale guidée par cathéter

Country Status (2)

Country Link
US (1) US10182712B2 (fr)
WO (1) WO2009051698A2 (fr)

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JP2010264190A (ja) * 2009-05-18 2010-11-25 Hoya Corp 挿管支援具、挿管支援装置および挿管支援システム
JP2010264191A (ja) * 2009-05-18 2010-11-25 Hoya Corp 挿管支援具、挿管支援装置および挿管支援システム
EP2433553A1 (fr) * 2010-09-23 2012-03-28 Karl Storz Endovision, Inc. Stylet vidéo avec extrémité dirigeable
US9833586B2 (en) 2009-05-18 2017-12-05 Nihon Kohden Corporation Intubation assistance instrument, intubation assistance apparatus and intubation assistance system
CN111666998A (zh) * 2020-06-03 2020-09-15 电子科技大学 一种基于目标点检测的内窥镜智能插管决策方法
US11344690B2 (en) * 2014-09-16 2022-05-31 Truphatek International Ltd. Imaging device and data management system for medical device

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